College receives grant to provide colonoscopy training to faculty and residents

By Kimberly Florence

The College of Community Health Sciences wants to increase the number of colonoscopy procedures performed by family medicine physicians in underserved communities of rural Alabama, and it plans to accomplish this goal through a grant from the American Cancer Society.

Dr. Richard Friend, director of the College’s Family Medicine Residency, applied for the grant in early 2016. In June 2016, the College received an endowment of $70,000 that matched an additional $70,000 from CCHS.

The money will be used to fund colonoscopy training for the Family Medicine faculty and residents, said Friend.

“The purpose of this grant is to train more providers to do colonoscopies throughout the state,” he said. “The way we are approaching that is by training more faculty who will in turn train more residents.”

The grant will fund the purchase of a high-fidelity simulator that faculty and residents will use to learn. The simulator uses computerized manikins to guide providers through performing the procedure and records proficiency. Once providers have met certain requirements, they can to move on to assisted cases in surgery with live patients. Friend says the simulator will be purchased in about a month.

Residents will begin their training under the direction of Friend. Dr. Drake Lavender, associate professor of Family Medicine.

Two faculty members will also receive training: Dr. Jared Ellis, associate director of the Residency, and Dr. Ed Geno, associate professor of Family Medicine. Once they complete their training, they will join Friend and Lavender in training residents.

The majority of residencies across the country do not provide colonoscopy training and family medicine physicians perform only 8 percent of colonoscopies in the state, said Friend. By training more family physicians to perform the procedure, the College hopes to provide greater access to patients in rural areas who may not be able to get to an urban setting where the majority of colonoscopies are performed, said Friend.

“There are people in our region who can’t get to the larger metropolitan areas like Tuscaloosa and Birmingham,” Friend said. “We hope to provide these services in smaller rural medical centers where they’re needed the most.”

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region through the provision of high quality, accessible healthcare, and one of the ways it does that is by sending its trained physicians into Alabama’s rural and underserved communities.

Immunizations in older adults, addiction and teens, schizophrenia and cholesterol topics in weekly Mini Med School lecture series

About one-third of people will get shingles in their lifetime, and while the shingles vaccine is only about 50 percent effective, it is still worth it to avoid getting the virus, said Dr. Jane Weida, director of clinical affairs for the College of Community Health Sciences’ Department of Family, Internal, and Rural Medicine.

Weida gave her talk, “Immunizations for Older People — Staying Sharp on Shots,” on Feb. 9 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. The lecture series is open to OLLI participants and to the public.

Shingles is caused by the same virus that causes chickenpox. A painful rash develops, usually on a single area on one side of the body, that can be very painful, said Weida, who is also an associate director of The University Family Medicine Residency, operated by CCHS, and an associate professor of Family Medicine.

View Fox 6’s report on Weida’s talk:

Someone who has had chickenpox can get shingles.

“When you’re little you get chickenpox and then the virus stays in the nerves along the back and neck,” said Weida. “Sometimes, we don’t know how, it reactivates.”

Being older, having poor immune function and having had chickenpox before 18 months of age increases the risk of shingles.

“If you never have had the chickenpox, you can’t get shingles first,” she said. “If you’ve never been immunized for chickenpox or shingles, you should get immunized for both. You can catch chickenpox from someone with shingles, but not shingles.”

Insurance will cover the shingles vaccine after age 60, though it can be given starting at age 50.

Older people need immunizations to boost immunity to diseases, even those to which they have already been immunized, such as tetanus, diphtheria and whooping cough, and to protect against diseases that affect older adults preferentially, including shingles and pneumonia, said Weida.

Weida also encouraged attendees to get their flu shot each year, as 3 million to 5 million people are infected by influenza each year, and 250,000 to 500,000 die each year from the flu. The best time to get your flu shot is about mid-October to November, said Weida.

The flu shot’s effectiveness can fade, Weida said, so it is important not to get it  too early, especially for those older than 65.

The flu is spread through coughing or sneezing and by touching surfaces with the virus. However, soap and water deactivates the virus, Weida said.

Schizophrenia
On Feb. 2, Dr. Thaddeus Ulzen, associate dean of Academic Affairs and chair of Psychiatry and Behavioral Medicine, gave his talk on schizophrenia, which is a chronic and severe mental disorder that affects 1 percent of people worldwide.

Symptoms typically present between late adolescence and early adulthood. Ulzen said that symptoms may be subtle, but those around the person may notice that “something is just not quite right, or the person is not his or herself.”

Symptoms include hallucinations, delusions, thought disorders and movement disorders. Reduced emotions and feelings of pleasure and reduced speaking may also be symptoms.

“I describe it as a disruption of what I call ‘security of thought’—that your thoughts belong to you,” said Ulzen. “The feeling is that someone is intruding on your thoughts.”

Medication can be used to treat schizophrenia, but other aspects must be introduced into the treatment, said Ulzen, including psychosocial interventions and cognitive behavioral therapy. Community treatment, which includes family education and support, is also important.

Schizophrenia cannot be cured, and those affected with the disorder have it for life.

“As a child psychiatrist, I always say that we are in preventive psychiatry. Most disorders we see, including schizophrenia, start quite young.”

Ulzen said he works with general physicians to help them identify the signs of schizophrenia and other psychiatric disorders.

“My job is to help physicians understand that this is the beginning of the big tsunami about to come and never to say ‘It’s just a phase.’ If the patient is concerned enough to walk into the room, they know something is wrong.”

 

Addiction and Teens
In a 2015 study, one out of 17 high school seniors were daily smokers of tobacco, said Dr. Sara Phillips, assistant professor of Pediatrics at CCHS, during her talk “Addiction and Teens” on Feb. 16.

According to the CDC, cigarette smoking causes about one of every five deaths in the US each year and life expectancy for smokers is at least 10 years shorter than for nonsmokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, said Phillips.

“I think if we target young people and try to get them to quit early on, it could be like they never smoked.”

Most teens want to quit, she said, and nicotine replacement and cognitive behavioral intervention can be helpful forms of treatment.

While there are other dangerous drugs that teenagers use, smoking causes annually more deaths than overdoses have in 15 years, said Phillips.

More money is spent on tobacco advertising than any other drug, though there are regulations.

Advertising for alcohol is not regulated, and people aged 12 to 20 years drink 11 percent of all alcohol consumed in the US. More than 100,000 deaths can be attributed to excess alcohol consumption, including the deaths of 5,000 people younger than 21 years, said Phillips.

Younger drinkers are more likely to develop alcohol dependence or abuse later in life, and they are at higher risk of suicide and death from alcohol poisoning. This is for a couple of reasons, said Phillips.

“One, their brains are not fully developed, and two, they’re novices to drinking. They don’t know their limits,” she said.

Of illegal drugs, marijuana is the most commonly used and adolescents can become addicted, despite popular belief, said Phillips.

One study showed an average loss of eight IQ points with heavy marijuana use as a teen and continued use as an adult. It can also lead to memory problems, breathing issues and hallucinations and paranoia.

Genetics can play a role in addiction in teens. Children whose parents are alcohol-dependent are four to six times more likely to develop alcohol dependence compared to others with no family history. Teens with mental health issues are also more at risk to use or abuse substances, Phillips said.


Cholesterol
Treating cholesterol isn’t about treating a number—it’s about treating the risk factors and the disease process, said Dr. Ed Geno, assistant professor of Family Medicine in the College’s Department of Family, Internal, and Rural Medicine.

Cholesterol is essential in the human body, said Geno. Two types of cholesterol levels are checked: LDL and HDL. The two have different clinical implications:

LDL carries cholesterol from the liver to the tissues and deposits it. Geno called this “lousy cholesterol,” which is how he helps patients remember it is not good for that number to be too high.

“Happy cholesterol” is how Geno helps patients remember HDL, which carries cholesterol from the tissues back to the liver.

High levels of the LDL cholesterol can lead to plaque buildup in arteries and lead to cardiovascular disease (CVD).

Statins may be used to prevent CVD in adults.

“We are trying to use primary prevention in treating cholesterol,” Geno said. “That means we are trying to keep someone from ever having a heart attack. Secondary prevention would be keeping a heart attack from happening again.”

When treating a person’s cholesterol, risk factors and the disease process is taken into account—not just the patient’s cholesterol numbers.

Adults without a history of CVD may be prescribed a statin for the prevention of a CVD event and mortality  depending on if: 1) the adult is between age 40 and 75; 2) the adult has one or more CVD risk factors, which include dyslipidemia, diabetes, hypertension or smoking; and 3) the there is a calculated risk by the physician of a cardiovascular event within 10 years.

Pickens County high school students visit College

Two dozen Pickens County high school students interested in health careers visited the College as part of a program of The University of Alabama-Pickens County Partnership.

The students are members of Exploring Professional Opportunities (EXPO), a program for sophomore and junior high school students to learn about career opportunities, scholarships and college life.

The UA-Pickens County Partnership, which is led by CCHS, works to place UA students in medicine, nursing, social work, nutrition, psychology and health education – and potentially others – in Pickens County for internships and other experiences. The rural county is provided with additional health resources, and UA students receive real world training in their respective areas of study.

Patti Pressley-Fuller, Pickens County Cooperative Extension Coordinator and a member of the partnership’s Advisory Committee, said EXPO gives students “an opportunity to open their minds to careers, a bigger world and a brighter future.”

During their time at the College, the students heard from Dr. Dan Avery, director of medical student admissions. Avery said the most frequent question he gets from students is how can they pay for medical school? “Don’t let that be an impediment. There are scholarships, grants, all kinds of things that are available,” he said. “We desperately need primary care physicians in this state and in this country, and the most likely people to practice in rural and underserved areas are people who grew up there.”

The College, which also functions as a regional campus of the University of Alabama School of Medicine, educates and trains medical students and resident physicians, with a focus on primary care.

The students asked Avery what undergraduate degrees help students get into medical school. “Make sure you get the required courses in biology and chemistry, but medical schools want students who are well rounded,” he said. “Medicine is problem solving.”

He said communications skills are essential. “Doctors have to talk to patients long enough, and they have to listen.”

Shawn McDaniel, a Pickens County high school teacher who accompanied the students, added that “people skills and communication are a big thing. Young people can text, but face-to-face communication is harder. But you have to be able to do that because as a doctor you’re taking care of people.”

In addition to visiting the College and touring its University Medical Center, the students observed a mock hospital simulation at UA’s Capstone College of Nursing, visited UA biology laboratories, heard a presentation from the director of UA’s Early College program, ate lunch at a dormitory cafeteria and received a tour of Bryant-Denny Stadium.

College’s magazine honored for excellence

The College’s semi-annual magazine, On Rounds, received an Award of Excellence from the Council for Advancement and Support of Education, earning recognition as one of the best university magazines in the Southeast.

OR-Winter-2016_Reduced-1The award-winning 72-page issue, published in winter 2016, featured a package of articles about the College’s core values and the employees who exemplify them, and the College’s ongoing work to meet its mission of improving health in Alabama and the region. View the winter 2016 issue here. 

Brett Jaillet, assistant director of Communications for the College, is editor of On Rounds and oversaw all aspects of the issue’s production—from conception and development of content, to layout, creative design and publication.

On Rounds is a key component of the College’s communications efforts.

CASE is an international professional association serving educational institutions and the professionals who work on their behalf in communications, alumni relations, development, marketing and advertising and related areas.

Meeting the Fellows: Judson

Before I began working in Pickens County, I had little experience with agriculture-based communities. I was even less familiar with the seemingly paradoxical association of those communities with food deserts. According to the USDA, a food desert is an area lacking healthy food options or where unhealthy food options are more accessible than healthy options. While working in Pickens County, I began to understand more about the wide variety of factors that impact health, especially when it comes to access to healthy food and health care.

I saw firsthand the importance of the biopsychosocial model of health, which uses interactions between biological, psychological, and social factors to determine health status, in rural communities.  My personal experiences, coupled with the success I saw with the Druid City Garden Project in Tuscaloosa, AL, led me to choose gardening as the focus for my work in Pickens County. I began by working with the 4H organization in Gordo, AL, an after-school educational and extracurricular activity for kids aged 9-14 that was already in place. I installed raised-bed gardens and taught about gardening, nutrition, and sustainability twice a week. Sometimes I felt as though I was learning just as much, if not more, as the kids I taught. While the kids in the organization learned about healthy foods and being outdoors, I learned how to impact kids on a level that they understand and can be excited about. The most important lesson I have learned so far—one that applies to gardening and medicine–is the value of patience.

I have also learned more about social responsibility, something crucial in a small community. My class decided to donate our harvest to the food pantry across the street to give back to the underserved community. The initiative and enthusiasm I have seen in the kids I work with has inspired me to expand this program to other parts of Pickens County. Other current and upcoming efforts include a community garden, a teaching garden at one of the local schools, and a therapy garden for a local senior center. I can’t wait to see what comes from this project!

Meeting the Fellows: Courtney

My name is Courtney and I am originally from a large suburb of Chicago called Naperville, Illinois. I graduated summa cum laude from The University of Alabama in May 2016 with a BS in biology and a BA in psychology. I will start medical school in the fall of 2017, though I haven’t yet decided where I will attend! During my undergraduate career at UA, I studied neurodegenerative disorders, like Alzheimer’s and Parkinson’s disease, under Dr. Kimberlee Caldwell. My research has been published, and I was named a Goldwater Scholar in 2015. Research is one of my truest passions, so I’m interested in a career in academic medicine. This career would allow me to serve my community as a physician, an educator and a medical researcher.

The project that I have been working on this year is nutrition education. According to the National Institutes of Health (NIH), 35.7 percent of American adults are obese. In the state of Alabama, the percentage of obese adults is even higher than the national average, and the percentage of obese adults is still higher in Pickens County. In Pickens County, I am teaching basic nutrition education, like how to read and interpret a food label, to high schoolers and children aged 9-14. In addition to the nutrition education, my project has a cooking component in which I get to teach students how to prepare recipes that are easy, healthy and affordable.

We have made many different recipes over the last few months, but a favorite for the kids was the Caesar Pasta Salad. We prepared this recipe after I gave a lecture on carbohydrates. I try to make my lectures fun and engaging so that students retain and understand the relevance of the material. A few weeks ago, when we were talking about sugar, the high school students engaged in a debate on a soda tax that recently went into effect in California. I try to teach them things that will be useful when they’re at the store; one thing that many students were shocked to learn was that orange juice, which many people drink as a “healthy” alternative to soda, has nearly the same amount of sugar as soda does! They’ve learned that there is a direct correlation between sugar consumption and obesity, so hopefully they’ll rethink their drink choices when they’re in the cafeteria.

My time working with the UA-Pickens County Partnership has been the single-most transformative experience of my life. Working in Pickens County has been an unparalleled introduction to serving the medically underserved, which is something that I hope to do for the rest of my life. I have learned specifically that people lack the resources, not the willpower, to make healthy decisions and that is something that I will remember in my future career as a physician. I can now appreciate that the social determinants of health are just as important as the physiological determinants of health that we commonly associate with medicine, and that a person is so much more than their medical chart makes them out to be.

I am grateful for my time so far in Pickens County this year and I cannot wait for new students and more organizations to work with next semester!

WBRC: Immunizations for the Elderly

Dr. Jane Weida discusses the importance of immunization shots for elderly individuals.

 

McKinney Selected for Fellowship

Robert McKinney, assistant professor of social work in the department of Psychiatry and Behavioral Medicine at The University of Alabama’s College of Community Health Sciences, was among 16 faculty nationwide chosen for the 2018 class of the Society of Teachers in Family Medicine’s Behavioral Science/Family Systems Educator Fellowship.

Bama Theatre’s ‘Evening of African Film’ showcases the continent’s culture

The fifth annual Tuscaloosa Evening of African Film, co-sponsored by the University of Alabama College of Community Health Sciences, will be held this Saturday. This year’s 
marquee film is a 2014 Nigerian production called “Dazzling Mirage,” which tells the story of a young woman with 
sickle-cell disease.

Dean talks to Alabama Public Radio about potential impact of Affordable Care Act repeal

The Affordable Care Act is seen as one of the defining pieces of President Obama’s legacy – and the new Republican majority has targeted it for repeal. Leading lawmakers in both houses of Congress have begun work dismantling Obamacare – despite not having any plan in place for a replacement, and despite polling that suggests an overwhelming majority of Americans oppose its repeal without a replacement ready.